MEDICARE: MS. BEULAH L BAYLOR LICENSE NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	132141	TX

General Provider Information

NPI Number	:	1568664464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEULAH L BAYLOR LICENSE NURSE

Provider Business Mailing Address
First Line	:	14220 PARK ROW
Second Line	:	APT 1022
City	:	HOUSTON
State	:	TX
Zip	:	77084-5190
Country	:	US
Telephone Number	:	281-596-8683
Fax Number	:	832-550-2893

Provider Business Practice Location Address
First Line	:	14220 PARK ROW
Second Line	:	APT 1022
City	:	HOUSTON
State	:	TX
Zip	:	77084-5190
Country	:	US
Telephone Number	:	281-596-8683
Fax Number	:	832-550-2893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2007
Last Update Date	:	07/08/2007

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